|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
IP
|
$396.23
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$336.80 |
| Rate for Payer: Adventist Health Commercial |
$79.25
|
| Rate for Payer: Blue Shield of California Commercial |
$200.89
|
| Rate for Payer: Blue Shield of California Commercial |
$304.70
|
| Rate for Payer: Cash Price |
$178.30
|
| Rate for Payer: Cigna of CA HMO |
$277.36
|
| Rate for Payer: Cigna of CA PPO |
$277.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$277.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.49
|
| Rate for Payer: EPIC Health Plan Senior |
$158.49
|
| Rate for Payer: Galaxy Health WC |
$336.80
|
| Rate for Payer: Global Benefits Group Commercial |
$237.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$251.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$233.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.10
|
| Rate for Payer: Multiplan Commercial |
$316.98
|
| Rate for Payer: Networks By Design Commercial |
$198.12
|
| Rate for Payer: Prime Health Services Commercial |
$336.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.71
|
| Rate for Payer: United Healthcare All Other HMO |
$144.74
|
| Rate for Payer: United Healthcare HMO Rider |
$141.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.77
|
|
|
HEPATITIS B VACCINE 20 MCG/0.5 ML-ADJUVANT CPG 1018 (PF) IM SYRINGE [222472]
|
Facility
|
OP
|
$396.23
|
|
|
Service Code
|
HCPCS 90739
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$1,234.43 |
| Rate for Payer: Adventist Health Commercial |
$79.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,234.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$336.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$297.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.19
|
| Rate for Payer: Blue Shield of California Commercial |
$177.16
|
| Rate for Payer: Cash Price |
$178.30
|
| Rate for Payer: Cash Price |
$178.30
|
| Rate for Payer: Cigna of CA HMO |
$277.36
|
| Rate for Payer: Cigna of CA PPO |
$277.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$336.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$336.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$277.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.49
|
| Rate for Payer: EPIC Health Plan Senior |
$158.49
|
| Rate for Payer: Galaxy Health WC |
$336.80
|
| Rate for Payer: Global Benefits Group Commercial |
$237.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$251.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$345.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$233.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$277.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$277.36
|
| Rate for Payer: Multiplan Commercial |
$316.98
|
| Rate for Payer: Networks By Design Commercial |
$198.12
|
| Rate for Payer: Prime Health Services Commercial |
$336.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$237.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$237.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.71
|
| Rate for Payer: United Healthcare All Other HMO |
$144.74
|
| Rate for Payer: United Healthcare HMO Rider |
$141.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$336.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.80
|
| Rate for Payer: Vantage Medical Group Senior |
$336.80
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
IP
|
$70.46
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$59.89 |
| Rate for Payer: Adventist Health Commercial |
$14.09
|
| Rate for Payer: Blue Shield of California Commercial |
$35.72
|
| Rate for Payer: Blue Shield of California Commercial |
$54.18
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cigna of CA HMO |
$49.32
|
| Rate for Payer: Cigna of CA PPO |
$49.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.18
|
| Rate for Payer: EPIC Health Plan Senior |
$28.18
|
| Rate for Payer: Galaxy Health WC |
$59.89
|
| Rate for Payer: Global Benefits Group Commercial |
$42.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$56.37
|
| Rate for Payer: Networks By Design Commercial |
$35.23
|
| Rate for Payer: Prime Health Services Commercial |
$59.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.44
|
| Rate for Payer: United Healthcare All Other HMO |
$25.74
|
| Rate for Payer: United Healthcare HMO Rider |
$25.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.08
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML IM SYRINGE [118672]
|
Facility
|
OP
|
$70.46
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$220.18 |
| Rate for Payer: Adventist Health Commercial |
$14.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.14
|
| Rate for Payer: Blue Shield of California Commercial |
$33.34
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cigna of CA HMO |
$49.32
|
| Rate for Payer: Cigna of CA PPO |
$49.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.18
|
| Rate for Payer: EPIC Health Plan Senior |
$28.18
|
| Rate for Payer: Galaxy Health WC |
$59.89
|
| Rate for Payer: Global Benefits Group Commercial |
$42.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.32
|
| Rate for Payer: Multiplan Commercial |
$56.37
|
| Rate for Payer: Networks By Design Commercial |
$35.23
|
| Rate for Payer: Prime Health Services Commercial |
$59.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.44
|
| Rate for Payer: United Healthcare All Other HMO |
$25.74
|
| Rate for Payer: United Healthcare HMO Rider |
$25.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.89
|
| Rate for Payer: Vantage Medical Group Senior |
$59.89
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
OP
|
$70.46
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$220.18 |
| Rate for Payer: Adventist Health Commercial |
$14.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.14
|
| Rate for Payer: Blue Shield of California Commercial |
$33.34
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cigna of CA HMO |
$49.32
|
| Rate for Payer: Cigna of CA PPO |
$49.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.18
|
| Rate for Payer: EPIC Health Plan Senior |
$28.18
|
| Rate for Payer: Galaxy Health WC |
$59.89
|
| Rate for Payer: Global Benefits Group Commercial |
$42.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.32
|
| Rate for Payer: Multiplan Commercial |
$56.37
|
| Rate for Payer: Networks By Design Commercial |
$35.23
|
| Rate for Payer: Prime Health Services Commercial |
$59.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.44
|
| Rate for Payer: United Healthcare All Other HMO |
$25.74
|
| Rate for Payer: United Healthcare HMO Rider |
$25.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.89
|
| Rate for Payer: Vantage Medical Group Senior |
$59.89
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/0.5 ML INTRAMUSCULAR. [4081931]
|
Facility
|
IP
|
$70.46
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$59.89 |
| Rate for Payer: Adventist Health Commercial |
$14.09
|
| Rate for Payer: Blue Shield of California Commercial |
$35.72
|
| Rate for Payer: Blue Shield of California Commercial |
$54.18
|
| Rate for Payer: Cash Price |
$31.71
|
| Rate for Payer: Cigna of CA HMO |
$49.32
|
| Rate for Payer: Cigna of CA PPO |
$49.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.18
|
| Rate for Payer: EPIC Health Plan Senior |
$28.18
|
| Rate for Payer: Galaxy Health WC |
$59.89
|
| Rate for Payer: Global Benefits Group Commercial |
$42.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$56.37
|
| Rate for Payer: Networks By Design Commercial |
$35.23
|
| Rate for Payer: Prime Health Services Commercial |
$59.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.44
|
| Rate for Payer: United Healthcare All Other HMO |
$25.74
|
| Rate for Payer: United Healthcare HMO Rider |
$25.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.08
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
IP
|
$85.76
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Adventist Health Commercial |
$17.15
|
| Rate for Payer: Blue Shield of California Commercial |
$43.48
|
| Rate for Payer: Blue Shield of California Commercial |
$65.95
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Cigna of CA HMO |
$60.03
|
| Rate for Payer: Cigna of CA PPO |
$60.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.30
|
| Rate for Payer: EPIC Health Plan Senior |
$34.30
|
| Rate for Payer: Galaxy Health WC |
$72.90
|
| Rate for Payer: Global Benefits Group Commercial |
$51.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.58
|
| Rate for Payer: Multiplan Commercial |
$68.61
|
| Rate for Payer: Networks By Design Commercial |
$42.88
|
| Rate for Payer: Prime Health Services Commercial |
$72.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.19
|
| Rate for Payer: United Healthcare All Other HMO |
$31.33
|
| Rate for Payer: United Healthcare HMO Rider |
$30.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.09
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 10 MCG/ML INTRAMUSCULAR SUSP [119731]
|
Facility
|
OP
|
$85.76
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$220.18 |
| Rate for Payer: Adventist Health Commercial |
$17.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$73.14
|
| Rate for Payer: Blue Shield of California Commercial |
$33.34
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Cigna of CA HMO |
$60.03
|
| Rate for Payer: Cigna of CA PPO |
$60.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.30
|
| Rate for Payer: EPIC Health Plan Senior |
$34.30
|
| Rate for Payer: Galaxy Health WC |
$72.90
|
| Rate for Payer: Global Benefits Group Commercial |
$51.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.03
|
| Rate for Payer: Multiplan Commercial |
$68.61
|
| Rate for Payer: Networks By Design Commercial |
$42.88
|
| Rate for Payer: Prime Health Services Commercial |
$72.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.19
|
| Rate for Payer: United Healthcare All Other HMO |
$31.33
|
| Rate for Payer: United Healthcare HMO Rider |
$30.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.90
|
| Rate for Payer: Vantage Medical Group Senior |
$72.90
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
IP
|
$89.22
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Adventist Health Commercial |
$17.84
|
| Rate for Payer: Blue Shield of California Commercial |
$45.23
|
| Rate for Payer: Blue Shield of California Commercial |
$68.61
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cigna of CA HMO |
$62.45
|
| Rate for Payer: Cigna of CA PPO |
$62.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.69
|
| Rate for Payer: EPIC Health Plan Senior |
$35.69
|
| Rate for Payer: Galaxy Health WC |
$75.84
|
| Rate for Payer: Global Benefits Group Commercial |
$53.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.41
|
| Rate for Payer: Multiplan Commercial |
$71.38
|
| Rate for Payer: Networks By Design Commercial |
$44.61
|
| Rate for Payer: Prime Health Services Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.48
|
| Rate for Payer: United Healthcare All Other HMO |
$32.59
|
| Rate for Payer: United Healthcare HMO Rider |
$31.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.22
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 20 MCG/ML INTRAMUSCULAR SYRINGE [118608]
|
Facility
|
OP
|
$89.22
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$489.30 |
| Rate for Payer: Adventist Health Commercial |
$17.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$489.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.47
|
| Rate for Payer: Blue Shield of California Commercial |
$82.42
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cash Price |
$40.15
|
| Rate for Payer: Cigna of CA HMO |
$62.45
|
| Rate for Payer: Cigna of CA PPO |
$62.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$62.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.69
|
| Rate for Payer: EPIC Health Plan Senior |
$35.69
|
| Rate for Payer: Galaxy Health WC |
$75.84
|
| Rate for Payer: Global Benefits Group Commercial |
$53.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$56.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.45
|
| Rate for Payer: Multiplan Commercial |
$71.38
|
| Rate for Payer: Networks By Design Commercial |
$44.61
|
| Rate for Payer: Prime Health Services Commercial |
$75.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.48
|
| Rate for Payer: United Healthcare All Other HMO |
$32.59
|
| Rate for Payer: United Healthcare HMO Rider |
$31.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.84
|
| Rate for Payer: Vantage Medical Group Senior |
$75.84
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
OP
|
$234.41
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$1,143.08 |
| Rate for Payer: Adventist Health Commercial |
$46.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,143.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$500.47
|
| Rate for Payer: Blue Shield of California Commercial |
$224.00
|
| Rate for Payer: Cash Price |
$105.48
|
| Rate for Payer: Cash Price |
$105.48
|
| Rate for Payer: Cigna of CA HMO |
$164.09
|
| Rate for Payer: Cigna of CA PPO |
$164.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.76
|
| Rate for Payer: EPIC Health Plan Senior |
$93.76
|
| Rate for Payer: Galaxy Health WC |
$199.25
|
| Rate for Payer: Global Benefits Group Commercial |
$140.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$170.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$148.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$164.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$164.09
|
| Rate for Payer: Multiplan Commercial |
$187.53
|
| Rate for Payer: Networks By Design Commercial |
$117.20
|
| Rate for Payer: Prime Health Services Commercial |
$199.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$140.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$140.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.97
|
| Rate for Payer: United Healthcare All Other HMO |
$85.63
|
| Rate for Payer: United Healthcare HMO Rider |
$83.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.25
|
| Rate for Payer: Vantage Medical Group Senior |
$199.25
|
|
|
HEPATITIS B VIRUS VACCINE RECOMB (PF) 40 MCG/ML INTRAMUSCULAR SUSP [108150]
|
Facility
|
IP
|
$234.41
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$199.25 |
| Rate for Payer: Adventist Health Commercial |
$46.88
|
| Rate for Payer: Blue Shield of California Commercial |
$118.85
|
| Rate for Payer: Blue Shield of California Commercial |
$180.26
|
| Rate for Payer: Cash Price |
$105.48
|
| Rate for Payer: Cigna of CA HMO |
$164.09
|
| Rate for Payer: Cigna of CA PPO |
$164.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.76
|
| Rate for Payer: EPIC Health Plan Senior |
$93.76
|
| Rate for Payer: Galaxy Health WC |
$199.25
|
| Rate for Payer: Global Benefits Group Commercial |
$140.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$148.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.26
|
| Rate for Payer: Multiplan Commercial |
$187.53
|
| Rate for Payer: Networks By Design Commercial |
$117.20
|
| Rate for Payer: Prime Health Services Commercial |
$199.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.97
|
| Rate for Payer: United Healthcare All Other HMO |
$85.63
|
| Rate for Payer: United Healthcare HMO Rider |
$83.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.77
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC
|
Facility
|
IP
|
$110,081.25
|
|
|
Service Code
|
MSDRG 421
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$110,081.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52,674.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$110,081.25
|
| Rate for Payer: EPIC Health Plan Senior |
$73,387.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66,715.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93,402.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89,399.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$139,708.02
|
|
|
Service Code
|
MSDRG 420
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$139,708.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$103,289.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$139,708.02
|
| Rate for Payer: EPIC Health Plan Senior |
$93,138.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$84,671.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118,540.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113,459.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$104,083.50
|
|
|
Service Code
|
MSDRG 422
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$104,083.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$42,427.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$104,083.50
|
| Rate for Payer: EPIC Health Plan Senior |
$69,389.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$63,080.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88,313.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84,528.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
IP
|
$257.90
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
901700022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.58 |
| Max. Negotiated Rate |
$219.22 |
| Rate for Payer: Adventist Health Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California Commercial |
$130.76
|
| Rate for Payer: Blue Shield of California Commercial |
$198.33
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cigna of CA HMO |
$180.53
|
| Rate for Payer: Cigna of CA PPO |
$180.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$180.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.16
|
| Rate for Payer: EPIC Health Plan Senior |
$103.16
|
| Rate for Payer: Galaxy Health WC |
$219.22
|
| Rate for Payer: Global Benefits Group Commercial |
$154.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$163.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$152.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.90
|
| Rate for Payer: Multiplan Commercial |
$206.32
|
| Rate for Payer: Networks By Design Commercial |
$128.95
|
| Rate for Payer: Prime Health Services Commercial |
$219.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.79
|
| Rate for Payer: United Healthcare All Other HMO |
$94.21
|
| Rate for Payer: United Healthcare HMO Rider |
$92.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.46
|
|
|
HEP B-DP(A)T-POLIO VACC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRINGE [34550]
|
Facility
|
OP
|
$257.90
|
|
|
Service Code
|
HCPCS 90723
|
| Hospital Charge Code |
901700022
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.58 |
| Max. Negotiated Rate |
$764.74 |
| Rate for Payer: Adventist Health Commercial |
$51.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$764.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$219.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$141.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$193.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.56
|
| Rate for Payer: Blue Shield of California Commercial |
$116.81
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cash Price |
$116.06
|
| Rate for Payer: Cigna of CA HMO |
$180.53
|
| Rate for Payer: Cigna of CA PPO |
$180.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$219.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$219.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$180.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.16
|
| Rate for Payer: EPIC Health Plan Senior |
$103.16
|
| Rate for Payer: Galaxy Health WC |
$219.22
|
| Rate for Payer: Global Benefits Group Commercial |
$154.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$163.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$152.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$180.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.53
|
| Rate for Payer: Multiplan Commercial |
$206.32
|
| Rate for Payer: Networks By Design Commercial |
$128.95
|
| Rate for Payer: Prime Health Services Commercial |
$219.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$154.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$154.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.79
|
| Rate for Payer: United Healthcare All Other HMO |
$94.21
|
| Rate for Payer: United Healthcare HMO Rider |
$92.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$219.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$219.22
|
| Rate for Payer: Vantage Medical Group Senior |
$219.22
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC
|
Facility
|
IP
|
$109,103.53
|
|
|
Service Code
|
MSDRG 354
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$109,103.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51,003.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$109,103.53
|
| Rate for Payer: EPIC Health Plan Senior |
$72,735.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$66,123.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92,572.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88,605.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC
|
Facility
|
IP
|
$130,745.09
|
|
|
Service Code
|
MSDRG 353
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$130,745.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$87,977.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$130,745.09
|
| Rate for Payer: EPIC Health Plan Senior |
$87,163.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$79,239.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110,935.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106,180.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC
|
Facility
|
IP
|
$103,116.39
|
|
|
Service Code
|
MSDRG 355
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$103,116.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40,775.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$103,116.39
|
| Rate for Payer: EPIC Health Plan Senior |
$68,744.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62,494.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87,492.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83,743.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$43,006.18
|
|
|
Service Code
|
APR-DRG 2273
|
| Min. Negotiated Rate |
$34,348.35 |
| Max. Negotiated Rate |
$43,006.18 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34,348.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43,006.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38,479.21
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$30,402.89
|
|
|
Service Code
|
APR-DRG 2272
|
| Min. Negotiated Rate |
$24,282.31 |
| Max. Negotiated Rate |
$30,402.89 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24,282.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30,402.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27,202.58
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$24,961.86
|
|
|
Service Code
|
APR-DRG 2271
|
| Min. Negotiated Rate |
$19,936.64 |
| Max. Negotiated Rate |
$24,961.86 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19,936.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24,961.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,334.29
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$105,452.41
|
|
|
Service Code
|
APR-DRG 2274
|
| Min. Negotiated Rate |
$84,223.18 |
| Max. Negotiated Rate |
$105,452.41 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$84,223.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105,452.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94,352.16
|
|
|
HIP AND FEMUR FRACTURE REPAIR
|
Facility
|
IP
|
$46,742.30
|
|
|
Service Code
|
APR-DRG 3083
|
| Min. Negotiated Rate |
$37,332.34 |
| Max. Negotiated Rate |
$46,742.30 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37,332.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46,742.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,822.06
|
|
